RN Case Managers! FT and per-diem opportunities!

South Shore Health; Weymouth (MA); On-site; USD 85,000 - 110,000; Full time

Job summary

South Shore Health is seeking compassionate and detail-oriented RN Case Managers to join our team in Weymouth, MA. This full-time and per-diem role coordinates patient care across the continuum to ensure optimal outcomes and high patient satisfaction.

The ideal candidate has RN licensure, a Bachelor's degree in nursing, 3-5 years of acute care case management experience, and CCM/ACM certification within two years of hire. Weekend/holiday rotation may apply.

Qualifications

• RN licensed with for Massachusetts; Bachelor’s degree in Nursing preferred.
• 3–5 years of acute care hospital case management experience.
• CCM/ACM certification within two years of hire.

Responsibilities

• Review medical records of observation and inpatient admissions to verify appropriate utilization and care delivery.
• Assist clinicians in determining observation status and support discharge planning to avoid delays.
• Participate in pre-admission evaluation and screening for reimbursement.
• Assess acute care needs and coordinate interventions for timely discharge to sub-acute settings.
• Inform patients and families about follow-up care options and payer networks.
• Communicate with multidisciplinary teams to optimize resource use and discharge.
• Maintain relationships with referral sources, insurers, and vendors.
• Support department goals and adapt to schedule needs and external demands.

Skills

Negotiation

Communication

Conflict resolution

Interdisciplinary collaboration

Management

Critical thinking

Time management

Multitasking

Healthcare financing

Data analysis

Education

Bachelor's degree in Nursing

Job description

We are seeking compassionate and detail-oriented RN Case Managers (FT and per-diem) to join our healthcare team!

The ideal candidate will coordinate patient care across the healthcare continuum, ensuring optimal outcomes, efficient resource utilization, and a high standard of patient satisfaction.

Job Responsibilities

• Reviewing the medical record of all observation and inpatient admissions and continued stays to ensure appropriate utilization and delivery of care.
• Plays an essential role in assisting physicians, nursing and staff with accurate determination of a patient’s observation status. The RN Case Manager is an important resource in preventing delayed discharges of observation patients.
• Participates in case finding and pre-admission evaluation screening to assure reimbursement.
• Assessing patient acute level of care needs and works to implement and coordinate interventions aimed at facilitating a safe and timely discharge plan to the appropriate sub-acute settings in collaboration with the Case Manager Specialist.
• Ensure that patient has received all information related to choice of follow-up care facilities according to patient and family preference and any ACO preferred contracted providers.
• Interacts, communicates, and intervenes with multi-disciplinary healthcare team in a purposeful, goal-directed fashion. Works pro-actively and utilizes critical thinking skills to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem resolution around issues of resource use and continued hospitalization, discharge planning.
• Establishes and maintains effective communication with all referral sources, insurers, vendors and patient supplier systems.
• Maintains consistently a professional commitment to institutions and department’s goals and objectives. Demonstrates flexibility to the department’s needs in relation to floor and work schedule, and any other internal and external demands on the department. Continually shows commitment to the Department by extending self when need arises.
• Maintains an updated knowledge base of and references resources outlining provider benefits for care choices, including public, private, and governmental payers and established / preferred ACO relations
• Department operational excellence, regarding safe and effective discharge planning; assures department delivers quality services in accordance with applicable policies, procedures and professional standards.
• Attains all agreed to goals and objectives within specified time frames, as part of the organization’s overall mission.
• Embraces technological solutions to work processes and practices. eDischarge, EHR, Interqual, MCCM, Epic, Workday

Job Requirements

Registered Nurse, Bachelor's prepared strongly preferred

3-5 years acute care hospital case management experience preferred. Critical Care or Emergency Department experience highly desirable

Required Licenses / Registrations

RN - Registered Nurse

ACM-Accredited Case Manager or CCM-Certified Case Manager within two years of hire

Knowledge, Skills and Abilities

• Demonstrated skills in the areas of: negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking, time management and ability to multitask in high stress environment.
• Healthcare financing, community and organizational resources, patient care processes, and data analysis.
• Utilization management as it relates to third party payers
• Post-acute care community resources
• Managed Care preferred.
• Excellent verbal and written communication skills required.
• Demonstrates flexibility via an ability to adapt to changing priorities and regulations.
• Basic computer skills required.

Work Schedule: 4 10's or 5 8's! weekend & holiday rotation required